Diverse Voices, Better Choices: Representation And Its Impact On Health

[00:00:00] If you enjoy podcasts like this, you should check out our other shows on Health Podcasts Network.

[00:00:06] For example, Hopeful Hits, hosted by Dr. Tara, guides and supports those on the often challenging

[00:00:12] and isolating journey of women's health concerns and infertility.

[00:00:16] There's a particularly powerful episode that you should check out called All Things Endometriosis,

[00:00:23] which dives deep into understanding the condition to help the many women who suffer from endometriosis

[00:00:28] and have no idea they have it, and healthcare providers who are uneducated about it, making

[00:00:33] the diagnosis process so difficult.

[00:00:37] Check out Hopeful Hits on your favorite podcast platform or visit healthpodcastnetwork.com

[00:00:58] Welcome to Beyond The Paper Gown.

[00:01:00] I'm your host, Dr. Mitzi Krockover.

[00:01:03] You know, here at Beyond The Paper Gown, we dive deep into women's health and the

[00:01:07] many factors that can impact it.

[00:01:10] Did you know, though, that some of those factors might be things that we don't typically consider?

[00:01:15] Things like who our doctors are and what kind of training they've received.

[00:01:19] And that training is based on research.

[00:01:21] And if the research doesn't include women or other underrepresented groups, it might

[00:01:26] not be accurate for those populations.

[00:01:29] And doctors, just like any human, come with biases that can also impact on how they

[00:01:34] care for their patients.

[00:01:36] Do you know what also can come with bias?

[00:01:38] AI.

[00:01:39] And finally, factors outside the healthcare system can greatly impact on our health in

[00:01:45] ways that are not always so evident.

[00:01:47] Today, we're going to address all of those issues and what we can do to receive better

[00:01:52] healthcare and achieve better health.

[00:01:55] We'll be talking to a true trailblazer in medicine research and advocacy who uses

[00:02:00] her experience as a black female cardiologist to inform her perspective on what is needed

[00:02:06] for better health for women, especially black women.

[00:02:09] Dr. Jane Morgan is a cardiologist and executive director of health and community

[00:02:14] education and led the COVID Task Force at Piedmont Health Care Corporation in Atlanta,

[00:02:19] Georgia.

[00:02:20] Piedmont is the largest healthcare system in the state of Georgia.

[00:02:24] Dr. Morgan also led groundbreaking projects at Piedmont, enhancing the success

[00:02:29] rates of healthcare innovations and expanding cardiovascular research in structural

[00:02:34] and valvular heart therapy.

[00:02:36] She's held many other influential roles, including CEO of 40 million Beats and

[00:02:41] worldwide director at Salve Pharmaceutical.

[00:02:44] And she also actively contributes to several national and regional boards

[00:02:48] focusing on health equity and technology.

[00:02:52] She's also the creator of the stairwell Chronicles, providing 60 seconds of

[00:02:56] information on specific health questions.

[00:02:59] And just a reminder, this podcast is for informational purposes only and

[00:03:04] should not be construed as medical advice.

[00:03:07] We encourage you to consult your healthcare provider to discuss your personal health

[00:03:12] issues.

[00:03:21] Dr. Jane Morgan, thank you for joining me today.

[00:03:24] Hi, Mitzi.

[00:03:25] I'm really pleased to be here today with you.

[00:03:27] You're a cardiologist and if I can, you are a black cardiologist,

[00:03:31] which is a rare breed.

[00:03:33] Right, a black female cardiologist.

[00:03:35] I'm sorry, a black female cardiologist, please.

[00:03:37] And so I'm really interested in about your journey about how you got there.

[00:03:44] So a not such a fascinating story.

[00:03:47] I grew up in a neighborhood of other physicians.

[00:03:53] And so I always had exposure to doctors.

[00:03:56] They were always, they're all men.

[00:03:59] And I think in the back of my mind, I really thought men were doctors and

[00:04:04] women were nurses when I was growing up in my neighborhood because the only

[00:04:08] physicians that I saw were the ones in my neighborhood.

[00:04:11] As I got older and I was in high school, probably even as latest high school,

[00:04:15] believe it or not, and started to give it some thought, I realized,

[00:04:17] oh wait, I can be a doctor too.

[00:04:19] Women can be doctors.

[00:04:21] So I went to college with the thought that I would major in science and

[00:04:25] go to medical school.

[00:04:26] And that's exactly what I did.

[00:04:28] In medical school, I actually wasn't sure what I wanted to do.

[00:04:33] In my neighborhood, we had two orthopedic surgeons.

[00:04:36] So I thought when I went to medical school, I would be an orthopedic surgeon for

[00:04:40] no reason other than those were the doctors that I knew, my neighbors were

[00:04:44] orthopedic surgeons.

[00:04:46] We also had a dermatologist and a family practitioner in the neighborhood.

[00:04:50] And so I went through different iterations.

[00:04:54] And so really I was doing my internal medicine residency.

[00:04:57] I was a doctor.

[00:04:58] I was at George Washington University rotating during my internal medicine

[00:05:02] residency, had an elective in the critical care unit, which really was pulmonary

[00:05:09] anesthesia, critical care.

[00:05:11] And then later to cardiology and really started to like it.

[00:05:15] And so then I volunteered to go through more electives of cardiology and

[00:05:20] then decided, you know what?

[00:05:21] I'd like to do a subspecialty in that.

[00:05:23] But I was far along.

[00:05:25] I was in my internal medicine residency.

[00:05:27] And so I think the lesson in that is to always be a student,

[00:05:30] always be willing to learn and expand and to grow.

[00:05:33] And you don't know in what direction life will take you.

[00:05:38] Sure.

[00:05:38] And when you were talking about, you saw, or you knew an orthopedic surgeon,

[00:05:43] or you knew I believe a dermatologist or whomever.

[00:05:46] So it's really, it's who you see.

[00:05:50] That's right.

[00:05:51] And I think that's true for so many women.

[00:05:53] And I can't help but think that now when women see you,

[00:05:58] that they start thinking, especially black women,

[00:06:00] that this is a possibility.

[00:06:02] Has that been your experience?

[00:06:04] You know, it's something that I've been thinking about more recently.

[00:06:07] And you really make a good point about your environment.

[00:06:10] And people don't have any control over the environments in which they're

[00:06:15] born into.

[00:06:16] And we start off and the child absorbs and becomes a sponge and learns

[00:06:21] all the things around them and then emulates that without even knowing it.

[00:06:24] I went to medical school to become an orthopedic surgeon

[00:06:27] without actually giving thought to why I wanted to be an orthopedic surgeon.

[00:06:31] That's because I had grown up my whole life with neighbors who are orthopedic

[00:06:34] surgeons, but I didn't connect the two.

[00:06:38] And then you meet someone and they see you as someone they'd like to emulate.

[00:06:43] So this is new for me to really just say, you know,

[00:06:47] am I someone that people want to emulate?

[00:06:50] I think about my life in many ways has been a challenge.

[00:06:54] Being a woman and being black and have had so many doors that have been close to me,

[00:06:59] have had to knock on doors much longer than I should have had to knock on them.

[00:07:04] I have gotten only a part of what I know I should have gotten.

[00:07:07] They've had to make lemonade out of lemons, have had to smile when I felt

[00:07:11] like crying, you know, and then suddenly for someone to say,

[00:07:15] oh, I'd like to be just like you.

[00:07:17] You're thinking like me? What?

[00:07:20] Do you know what you're talking about?

[00:07:22] And so, you know, the outside often doesn't relay what the struggle really has been.

[00:07:29] And so in that, I would like to say that hopefully in my struggle,

[00:07:33] I have made the path a little bit smoother for those coming behind me.

[00:07:38] And maybe, maybe I don't really look like what I've been through.

[00:07:44] And so perhaps that's a compliment to me.

[00:07:49] Well, you know,

[00:07:52] it again as you're speaking and I think about those women who, again,

[00:07:58] having been able to see someone like yourself and say, hey,

[00:08:02] I might be able to do that.

[00:08:04] I also wonder and you talk about the struggle about women.

[00:08:08] And again, I think black women, especially,

[00:08:12] but I think all women fall into this having a really difficult time

[00:08:16] in the health care system. Right.

[00:08:18] And so my guess is that you've also bridged that gap in a lot of ways.

[00:08:23] Right, you know, I would say I've walked in the gap.

[00:08:26] I can't say that I've actually bridged it because the chasm is so large.

[00:08:32] And I think it was very eye opening for me when I went to medical school

[00:08:36] and the way medicine was taught

[00:08:40] and the way medicine was not taught was very apparent.

[00:08:44] I think to both a woman and a black woman going through medical school.

[00:08:50] And I learned I asked a couple of questions that were culturally based.

[00:08:55] How would I recognize, you know, X, Y and Z on black skin?

[00:08:59] Or what if someone said X, Y and Z to you?

[00:09:02] And I got no responses to it.

[00:09:04] And, you know, I got the message early that that's not important.

[00:09:10] Or we don't know and we're not going to pursue it.

[00:09:14] And I realized there was a whole section of medicine with, you know, people,

[00:09:19] human beings where we just weren't really learning.

[00:09:24] We really didn't have a lot of information.

[00:09:26] And then later in my career on a guide involved in research

[00:09:29] and clinical trials, I was working at Solvay Pharmaceuticals and Abbott

[00:09:32] and in research and development and medical affairs and business development.

[00:09:36] I realized, started to learn even how drugs and devices are developed.

[00:09:41] And so that pervasive thinking even carried through from the very beginning

[00:09:46] of how we actually get the drugs to market, how we're developing them.

[00:09:50] Who's in our clinical trial?

[00:09:52] And most importantly, who's not in our clinical trials?

[00:09:56] And what this means?

[00:09:58] And it just, you know, you start to peel back the onion

[00:10:00] and it's just layer after layer after layer.

[00:10:04] I'm going to ask a really basic question and I'm going to apologize for it beforehand.

[00:10:09] But I just for our listeners, why is it important to have black men and women

[00:10:17] or other underrepresented populations?

[00:10:22] Why is it important to have them represented in medicine?

[00:10:27] When we look at where we've been and where we're going,

[00:10:32] there is a trust issue.

[00:10:34] That's number one.

[00:10:36] And people of every race, every demographic, every hue.

[00:10:42] For the most part, tend to see doctors with whom they have a trust.

[00:10:49] Trust is the major factor in this country.

[00:10:52] 80 percent of black Americans are actually seen by African American

[00:10:57] physicians for that very reason.

[00:11:00] Where can we go where we can trust first that there will be no harm

[00:11:05] that will come to us?

[00:11:07] Imagine we're the only demographic that actually picks their doctor

[00:11:11] based on where they first will not be harmed.

[00:11:15] Whereas other people go to the doctor to be healed.

[00:11:19] That's not our primary objective in going.

[00:11:22] We need to go first where we won't be harmed.

[00:11:25] And then you start to look at what is the representation in clinical trials?

[00:11:29] The leaders, the physician leaders of clinical trial to call principal

[00:11:33] investigators, we almost have no black people who are principal investigators

[00:11:37] because the drug companies don't reach out to them.

[00:11:40] They don't train them.

[00:11:41] They don't include them as leaders.

[00:11:43] If you don't have leaders and people who look like you in a system

[00:11:46] where there's not a lot of trust, then you still are not going to gain

[00:11:50] entry into people, into these clinical trials.

[00:11:53] And we'll continue to develop drugs that are not relevant for all parts

[00:11:58] of the population, which therefore then puts minority patients at further risk.

[00:12:04] You know, there's some untoward effect because it wasn't captured

[00:12:08] within a clinical trial because you and people like you were not included.

[00:12:12] People like you are not leaders in those clinical trials.

[00:12:16] And so it's just kind of one thing that gets the next,

[00:12:19] but gets the next, but gets the next.

[00:12:22] What is the antidote to that?

[00:12:27] So we've had a lot of reversals of things.

[00:12:31] You know, we had the Flexner report back in 1904 and 1905.

[00:12:36] And I think his name is Abraham Flexner.

[00:12:41] I have to remember was commissioned by the American Medical Association,

[00:12:45] actually, to do a report of all the medical schools here in the United States.

[00:12:49] At the time, we had about seven or eight HBCU medical schools,

[00:12:53] majority black medical schools.

[00:12:55] And at the end of that report, you recommended that certain medical schools

[00:12:59] be closed and, of course, the majority of the black institutions were closed.

[00:13:04] It left us with just two institutions, Howard and Mahary.

[00:13:09] We went along with two institutions for a long period of time until 1980s

[00:13:14] till 1980s when the Morehouse School of Medicine came about.

[00:13:17] And we're now moving to add more institutions, but 100 years later,

[00:13:22] more than 100 years later, that damage has been done.

[00:13:25] And we now look as a country at the shortage of physicians

[00:13:31] that we are facing as we move forward and our population ages.

[00:13:35] And we're facing a shortage of physicians.

[00:13:38] If those medical schools had just been allowed to stay open,

[00:13:42] there would have been another 35 to 45,000 physicians trained in this country.

[00:13:47] And that's an example of how racism initially hurts the targeted population,

[00:13:53] but ultimately it impacts negatively all of society.

[00:13:58] You mentioned in an article three factors that every black woman should ask her doctor.

[00:14:06] Would you go over those for us?

[00:14:08] Or three questions, three questions.

[00:14:12] So a couple of things I always want to talk about

[00:14:16] is the connection of OB obstetrics pregnancy to cardiology.

[00:14:21] And so I think you always need to ask,

[00:14:25] is my obstetrical history relevant?

[00:14:28] Meaning would you like to know something about my pregnancy?

[00:14:32] And here's what the answer to that question should be.

[00:14:35] Yes, please. Please tell me about your obstetrical history.

[00:14:40] Or better yet, they should have asked.

[00:14:42] Right.

[00:14:44] The reason for that is your history of pregnancy complications.

[00:14:50] If you had complications is relevant to your mortality,

[00:14:55] meaning how long you will live because it is relevant to your heart history.

[00:15:00] If you had complications in pregnancy, if you've ever heard these terms,

[00:15:04] preeclampsia, eclampsia, pregnancy induced hypertension,

[00:15:08] gestational hypertension, gestational diabetes.

[00:15:12] If you've heard any of those terms, you know, you may not exactly know what they are.

[00:15:15] But if you've heard them, you're like, oh, I think I think I had that.

[00:15:19] Then your risk of heart disease is now twice that of a woman who had a

[00:15:24] pregnancy who did not have those types of complications.

[00:15:28] And what should have happened after your baby was delivered safely,

[00:15:33] then you should have been referred to a cardiologist for long term

[00:15:36] management and prevention because we know

[00:15:40] that you have just failed your first stress test.

[00:15:44] A pregnancy is a volume overload.

[00:15:48] And your volume overload then stresses your heart.

[00:15:52] If you developed any of these complications, that's a fail stress test.

[00:15:56] So here's why it's important for all the specialties to come together.

[00:16:00] Another great example of why diversity works.

[00:16:03] We have specialties coming together with different perspectives.

[00:16:07] The obstetrician describes you as a pregnant female with preeclampsia.

[00:16:15] A cardiologist looking at the same patient would describe you as

[00:16:20] a volume overloaded female with a fail stress test.

[00:16:25] Do you see how those the focus of those is different?

[00:16:29] Both are important.

[00:16:31] One is focused on the baby, others focused on the mom.

[00:16:35] They both are important.

[00:16:37] They're looking at the same person with the same set of symptoms

[00:16:42] and diagnoses, but with different lens on that.

[00:16:45] And that's why it's really incredibly important. Absolutely.

[00:16:50] Do you remember the other two questions?

[00:16:53] If you are a woman in sort of your late 30s or early 50s,

[00:16:57] we want to absolutely talk about paraminopause and menopause symptoms.

[00:17:03] And you want to be able to talk with your physician about whether

[00:17:06] menopausal hormone therapy or estrogen therapy or some

[00:17:10] some combination of estrogen and progesterone is right for you.

[00:17:15] From a cardiologist's perspective, estrogen protects the heart.

[00:17:19] Estrogen has cardioprotective properties.

[00:17:21] It has anti-inflammatory properties.

[00:17:23] We know that chronic inflammatory processes

[00:17:27] increase the risk of heart disease, accelerate the development

[00:17:30] of heart disease, but not just heart disease, bone disease,

[00:17:34] cancer, rheumatoid arthritis, all types of diabetes,

[00:17:38] all types of chronic medical conditions.

[00:17:42] So we want to absolutely have a conversation

[00:17:46] about whether hormone therapy is an option for you.

[00:17:50] It's not an option for all women, but it is an option for most women.

[00:17:56] And we should have these conversations and don't settle for

[00:17:59] you're talking with your doctor about symptoms of menopause

[00:18:03] that you may or may not be aware.

[00:18:05] You may feel agitated.

[00:18:07] I do something called the stairwell chronicles where I sit on my stairs

[00:18:10] and I answer a question in 60 seconds or less.

[00:18:15] And one of the symptoms I say is, are you sick and tired of everybody?

[00:18:21] If you're sick and tired of everybody,

[00:18:24] then that's one of the symptoms of menopause, if that's in your age.

[00:18:27] And you've got to begin to think about that.

[00:18:29] And don't accept from your physician the prescription of an anti-depressant

[00:18:35] or take a vacation.

[00:18:37] You know, the the prescriptions of anti-depressants

[00:18:42] in the perimenopausal years, late 30s to early 50s in women actually doubles.

[00:18:49] We're not all depressed.

[00:18:51] We can't all be depressed.

[00:18:53] So maybe what we need to do is actually address

[00:18:56] what's causing the symptoms of menopause, which are these dropping estrogen levels.

[00:19:01] So we have a lot of different options.

[00:19:03] I want you to have this conversation.

[00:19:05] There are a multitude of symptoms.

[00:19:07] So I'm going to go over some of the bigger ones you've heard of,

[00:19:09] hot flashes, which we now call hot flushes or restlessness, feeling sweaty.

[00:19:16] We also see an increase in your cholesterol levels and increase in your blood pressure.

[00:19:22] You can feel brain fog, somewhat out of sorts.

[00:19:25] But then there's some others that I talk about in my stairwell chronicles

[00:19:28] that you may not have heard of, like your ears could start itching

[00:19:32] because your skin is drying out and that includes the skin inside of your ear.

[00:19:36] You could get a frozen shoulder where you now have pain

[00:19:39] with rotation and limited movement of that shoulder.

[00:19:44] So these are all things you can have a change in your taste buds.

[00:19:47] You could now have a drawer full of deodorants and antiperspirants

[00:19:50] and none of them work.

[00:19:52] And you just have this whole drawer.

[00:19:54] Nothing works anymore.

[00:19:56] These are all symptoms of going through paraminopausin, menopausin.

[00:19:59] Listen to me, we do not have to suffer.

[00:20:02] We've got to get this lexicon out of our conscious.

[00:20:07] It's not just us.

[00:20:08] It's society.

[00:20:09] Women are expected to suffer, suffer through it.

[00:20:15] Right?

[00:20:16] So many times that we said that to others, people have said it to us.

[00:20:19] Listen, we deserve to be able to present our best face forward,

[00:20:24] put our best foot forward, bring our best selves forward.

[00:20:28] If you are diminishing a large part of your population that is suffering

[00:20:35] with these paraminopausal symptoms, including memory lapses and brain fog

[00:20:39] and fatigue and irritability and you just dismiss it

[00:20:43] and these people step away from being productive citizens,

[00:20:47] then you're ultimately hurting yourself as well.

[00:20:50] I met Dr. Morgan this past January at the J.P. Morgan Health Care Conference

[00:20:55] where she was a featured panelist.

[00:20:57] She spoke about the fact that too often women are not taken seriously

[00:21:01] in the doctor's office and their concerns are dismissed with a there there.

[00:21:06] The there there, right?

[00:21:08] The physician generally a male, patch you on the shoulder.

[00:21:11] There, there, there.

[00:21:12] You'll be better.

[00:21:13] The hysterical woman in his office complaining about all kinds of things

[00:21:18] and all the tests are negative.

[00:21:21] You're just hysterical.

[00:21:23] You're just depressed.

[00:21:24] They're there, go home.

[00:21:25] It'll all be better.

[00:21:26] Have some coffee.

[00:21:27] Have a wine.

[00:21:29] This sort of thing.

[00:21:30] No, you know what I need?

[00:21:32] I need for you to have an educated conversation with me

[00:21:35] about menopausal hormone therapy.

[00:21:37] And if you can't do that, I'll be changing doctors.

[00:21:40] I'm not angry with you.

[00:21:42] And I appreciate all that you've done for me up until this point.

[00:21:45] But now I don't think we can continue this journey together

[00:21:48] because I need something else now at this point in my life.

[00:21:52] Thank you very much for all that you've done.

[00:21:54] Goodbye.

[00:21:55] And they're there.

[00:21:57] They're there.

[00:21:59] I wanted the other questions that you suggested,

[00:22:01] which I thought was really interesting,

[00:22:03] is are there any clinical trials I can get into?

[00:22:07] Right.

[00:22:08] And you know, that is such a great question

[00:22:12] that we have to take into account.

[00:22:14] Great question that we don't ask why,

[00:22:16] because we just don't know to ask it.

[00:22:19] Who goes to the doctor to say, hey,

[00:22:21] by the way, we didn't discuss clinical trials.

[00:22:24] Right. Nobody does that.

[00:22:26] But we should.

[00:22:29] And if your doctor doesn't know,

[00:22:31] we should push the doctor to find one,

[00:22:33] especially if you've got chronic medical conditions.

[00:22:36] If you've got chronic, I can say chronic medical condition.

[00:22:39] You've got chronic liver disease.

[00:22:41] I mean, when I say chronic medical conditions,

[00:22:42] things that can't be cured,

[00:22:44] that you've got to manage now for the rest of your life.

[00:22:47] High blood pressure,

[00:22:48] heart disease, diabetes, lung disease,

[00:22:52] liver disease, kidney disease.

[00:22:54] Generally, once you're diagnosed with these,

[00:22:56] they don't just disappear.

[00:22:57] They don't go away.

[00:22:58] You've got to manage this.

[00:23:00] These are chronic medical.

[00:23:01] Autoimmune, for example.

[00:23:02] If you've got something chronic or arthritis,

[00:23:05] then you're a great candidate to go into a clinical trial.

[00:23:09] And it's not to say you're the only demographic,

[00:23:12] but I'm just saying especially if you've got chronic medical conditions.

[00:23:15] And then obviously all other people always ask about clinical trials.

[00:23:19] And if your physician doesn't know,

[00:23:21] push that physician to get that information and get it back to you.

[00:23:24] You can always look on websites of your local universities

[00:23:28] and major medical centers in your area as well.

[00:23:31] So, you know,

[00:23:33] clinical trials are the bridge

[00:23:38] to health equity for women and for all populations

[00:23:43] that they have sort of been left out of medical advancements.

[00:23:48] Right?

[00:23:49] We we benefit from medical advancements sort of

[00:23:56] because the data wasn't gotten on us.

[00:23:59] Our doctors are smart enough

[00:24:02] to realize there has to be some extrapolation.

[00:24:05] So we may decrease the dose a little bit for a woman or that type of thing.

[00:24:09] But we really don't have the information specifically on women.

[00:24:13] And that's why menopause is still a mystery.

[00:24:16] Nobody studies menopause.

[00:24:17] Why I said earlier that most of the principal investigators were men.

[00:24:21] And so another reason why there needs to be representation and listen,

[00:24:26] health is wealth if once the industry recognizes how much money

[00:24:32] is on the table, women are the primary

[00:24:36] health care decision makers in the family for themselves

[00:24:40] and for everyone else to ignore this demographic seems really suicidal.

[00:24:45] But OK, as my mother used to say, OK, I guess you're going to find out.

[00:24:54] In November, the president announced the White House Research Initiative

[00:24:58] on women's health, promising more funding to women's health research

[00:25:02] and support for women's health.

[00:25:03] I asked Dr. Morgan about her thoughts on this new initiative.

[00:25:07] Love it, love it.

[00:25:09] I wish it had come sooner, but I love it.

[00:25:11] I think it's bringing awareness.

[00:25:13] I don't see enough actually for me.

[00:25:15] I don't see enough publicity on it.

[00:25:18] But I know the money is there.

[00:25:20] The dollars are there will start to move the needle.

[00:25:23] But it's it's really a fraction of what we need.

[00:25:27] But I'll take it because it's more than we have.

[00:25:30] But let's be honest, it's a fraction.

[00:25:32] We need money in the billions.

[00:25:35] So this was, you know, I don't want to say a drop in the bucket.

[00:25:39] I would say a start.

[00:25:40] It's a small start and it has big,

[00:25:47] you know, a big platform, the first lady of the White House.

[00:25:50] That's a huge platform.

[00:25:51] And so let's keep the ball rolling.

[00:25:54] Yeah, absolutely.

[00:25:56] What else needs to happen?

[00:25:59] Oh, my goodness. So, you know, when we talk about what needs to happen,

[00:26:03] the information that you and I are talking about today

[00:26:07] needs to be not only socialized amongst the population,

[00:26:10] but we've got to go back and start to retrain our physicians.

[00:26:14] When I say retrain our physicians all the way back in medical school,

[00:26:18] we've got to reintegrate into the medical school curricula.

[00:26:24] What this is, why it's important,

[00:26:27] how to manage all people's not just one

[00:26:32] and to make certain that when you leave medical school,

[00:26:35] your vision is broader than when you came in.

[00:26:41] And that has to start in medical school in your training.

[00:26:45] And then it's got to be reinforced during your residency

[00:26:49] and your practical application years and your fellowship.

[00:26:52] And because what we're trying to do now

[00:26:55] with all the doctors who are in their forties and fifties and sixties

[00:26:58] and seventies is unlearn something and then reteach it.

[00:27:05] That's harder because this is the way it's always been.

[00:27:08] So why don't we just teach it the right way from the beginning?

[00:27:10] I couldn't agree more.

[00:27:11] And, you know, I really look forward to a day where

[00:27:17] all students go, well, what are the gender differences?

[00:27:21] What are the sex differences?

[00:27:22] What are any ethnic or racial differences

[00:27:25] and not just be sponges of what is there?

[00:27:29] And I think that is so important.

[00:27:32] And that goes to the types of teachers,

[00:27:34] that the types of instructors and professors that you're hiring.

[00:27:39] And it doesn't mean it has to be any one type or another type,

[00:27:42] but that they also understand the breath and the scope

[00:27:48] of a global society

[00:27:51] and that we've got to train physicians that can go out

[00:27:54] and be leaders in the world and not just for a narrow demographic

[00:27:59] or else you're going to be obsolete.

[00:28:00] We've got to be able to ultimately be who we are,

[00:28:03] which was supposed to be public servants.

[00:28:07] We're supposed to be serving humanity.

[00:28:10] That is ultimately our charge.

[00:28:12] And we've got to broaden that definition of humanity

[00:28:17] and what that means.

[00:28:19] So the I was just at the Vive conference,

[00:28:23] which is which is focused on digital health and the key word was

[00:28:29] or key phrase was generative AI.

[00:28:32] And I can't help but think in terms of clinical decision support

[00:28:39] that that is a double edged sword because just as we want to have

[00:28:44] physicians who ask the question and are comfortable with,

[00:28:48] well, we don't know rather than it doesn't matter.

[00:28:51] And then we figure out what those gaps are and we can, you know,

[00:28:53] hopefully address them.

[00:28:56] Generative AI is going to go into the data that we have

[00:29:00] as flawed as it is.

[00:29:03] And it's going my concern is that it's going to provide

[00:29:07] flawed responses.

[00:29:09] Have you thought about that?

[00:29:10] And what are your thoughts?

[00:29:11] I think about it all the time.

[00:29:12] I think about even, you know, the algorithms and formulas

[00:29:15] that we have now that are flawed and have racial bias in them.

[00:29:19] Artificial intelligence so far is only as good as the person

[00:29:23] who's programming the software.

[00:29:26] And so here we go round and round and round and round.

[00:29:29] Who are the voices at the table?

[00:29:31] What is happening?

[00:29:32] How are these things being developed?

[00:29:34] Are there considerations for it?

[00:29:36] The first time a company hears about it,

[00:29:38] shouldn't be when they roll it out at a conference

[00:29:40] and someone raises their hand and asks a question and says,

[00:29:42] Hey, but the data that you're mining is incorrect.

[00:29:46] How does that work?

[00:29:47] And then that's the first time they've heard about it

[00:29:49] because they haven't had enough people at the table

[00:29:52] to make certain that they can develop a product

[00:29:53] that's actually relevant to everybody.

[00:30:01] You have really been vocal about obviously

[00:30:04] a number of health care topics.

[00:30:06] And maybe we've already talked about it.

[00:30:08] But what do you believe is currently the most pressing

[00:30:10] issue in our health care system?

[00:30:13] Oh boy, so many things.

[00:30:15] Maybe, maybe it's probably coming up top on my list

[00:30:20] is maternal mortality because it really encompasses

[00:30:28] the obstetrical history, the cardiovascular history,

[00:30:31] the menopause history.

[00:30:32] I can roll that in.

[00:30:34] And it's going to also wrap in a lot of black women

[00:30:38] because maternal mortality has the greatest negative impact

[00:30:44] in the black community as well.

[00:30:46] And so I think when we talk about maternal mortality,

[00:30:49] I can hit so many targets along the way that are important

[00:30:54] and that I talk about often

[00:30:56] and a lot of them roll into this topic.

[00:31:00] And I think it's important just to remind our audience

[00:31:03] that we are number, we, the United States

[00:31:05] are number 24th in the world

[00:31:09] in terms of our maternal mortality,

[00:31:12] meaning that we have some of the worst outcomes

[00:31:15] of any developed country,

[00:31:17] let alone some of the underdeveloped country.

[00:31:19] Why do you think that is?

[00:31:22] So for a number of reasons,

[00:31:26] one of them is just racism in the country

[00:31:30] and how populations are segregated

[00:31:35] and the segregation generally

[00:31:37] is also along financial lines.

[00:31:39] And so there's not economic advantage

[00:31:42] and health equals wealth

[00:31:45] and money can determine how many years you live

[00:31:49] in this country.

[00:31:50] I give lectures about who's going to live the longest.

[00:31:53] You don't even have to know anything

[00:31:54] about your medical background.

[00:31:55] If you know, you don't have to know their medical history.

[00:31:58] If you know something about their financial history,

[00:32:00] you can have an idea of who's going to live longer

[00:32:03] than someone else.

[00:32:04] And we call this the redlining of the zip codes

[00:32:06] and those types of things.

[00:32:07] So what foods are available?

[00:32:10] Money determines the choices that you make in life

[00:32:16] and those choices will determine your quality of health

[00:32:22] in this country.

[00:32:23] It is more expensive to be healthy.

[00:32:26] It's more expensive to eat fresh fruits

[00:32:29] and fresh vegetables and organic foods.

[00:32:32] That is very, very expensive.

[00:32:35] You can fit it within your budget.

[00:32:38] If you're only making $22,000 a year

[00:32:41] and you're a family of four,

[00:32:42] you're going to have a lot of processed foods

[00:32:44] because they're cheap and it's abundant

[00:32:46] and you can keep your family afloat.

[00:32:49] That's really just the bottom line.

[00:32:52] And I show a slide that always bothers me

[00:32:56] where we show what is the earnings gap

[00:33:02] between whites and blacks,

[00:33:03] depending on your educational level.

[00:33:06] Even with your most advanced degrees,

[00:33:10] a black person on average earns the same

[00:33:14] that a white person who has a high school diploma makes.

[00:33:17] That's the average.

[00:33:18] That's how hard it is to have melanin in your skin

[00:33:23] in this country.

[00:33:24] That's how hard it is.

[00:33:26] Then we have all the redlining.

[00:33:28] We know people in zip codes live

[00:33:30] have different opportunities.

[00:33:32] The amount of income that you make

[00:33:35] will determine the opportunities

[00:33:37] that you can provide for yourself and your children.

[00:33:40] What schools you go to, what neighborhoods you live in,

[00:33:42] if you have access to parks,

[00:33:44] are you able to learn other languages?

[00:33:46] Do you have fresh water?

[00:33:49] All of those kinds of things will be determined.

[00:33:51] Even the type of insurance you can have for your family.

[00:33:55] And don't forget,

[00:33:56] many people have the insurance

[00:33:59] insurance.

[00:34:00] Insurance is different levels.

[00:34:02] There's some insurance that's better

[00:34:03] than other insurance carriers,

[00:34:06] other insurance types.

[00:34:07] The type of insurance that you can afford

[00:34:10] will be determined by your earning potential.

[00:34:13] And if you can never earn,

[00:34:17] if you can never equalize your earning potential

[00:34:20] even with the most advanced degrees,

[00:34:24] it becomes such a heavy burden and a challenge.

[00:34:28] And this is how it all develops.

[00:34:31] And so what do you have?

[00:34:32] All the processed foods, then you've got obesity

[00:34:35] and then you've got diabetes.

[00:34:36] Then you have hypertension and people can't exercise.

[00:34:40] There's no access to parks.

[00:34:41] The neighborhoods aren't safe.

[00:34:43] Unemployment is high.

[00:34:44] But it just goes on and on and on.

[00:34:49] You know, thank you for those comments.

[00:34:53] When you started out saying,

[00:34:56] it's a racism.

[00:34:57] I think a lot of people and even including me,

[00:35:02] perhaps before thought,

[00:35:03] oh, it's just the doctor being racist against the patient.

[00:35:06] And we know that that's part of it too,

[00:35:09] that a lot of times black women,

[00:35:11] women in general, but black women may not be

[00:35:14] or maybe ignored even when they start talking about

[00:35:16] something that is bothering them.

[00:35:18] But this whole constellation

[00:35:21] of kind of the domino effect

[00:35:23] that you just talked about,

[00:35:25] that racism elicits is really just really mind blowing.

[00:35:31] So thank you for that kind of detail

[00:35:34] because it really does put things

[00:35:36] in a different perspective.

[00:35:37] And you can see where the problem isn't easily fixed.

[00:35:41] But hopefully that we can.

[00:35:48] So you've been a researcher, you've been a clinician

[00:35:51] and you also ran the COVID task force at Piedmont.

[00:35:55] And what was the most challenging part

[00:35:58] of combating that disease

[00:36:00] in the population that you served?

[00:36:02] Yeah, I think the most challenging thing was

[00:36:09] trying to understand, not even trying,

[00:36:11] clearly I did understand them,

[00:36:13] but maybe balancing the needs of our physicians,

[00:36:16] our nurses with trying to educate the public.

[00:36:22] So really it was too prong

[00:36:24] with regard to education,

[00:36:26] which was a large part of my role,

[00:36:28] making certain that doctors were educated

[00:36:30] because the landscape of COVID was moving quickly

[00:36:33] and making certain that people always had

[00:36:35] the latest up-to-date information.

[00:36:37] Trying to have conversations with the community

[00:36:41] who were often confused.

[00:36:43] And it was not so much that the information was confusing.

[00:36:49] It was that oftentimes the information was given

[00:36:51] in a way that was not generalizable

[00:36:55] to the entire population.

[00:36:57] And then compounding that,

[00:36:59] you had people who were intentionally confusing messages

[00:37:03] on social media.

[00:37:04] So it started to just become a big thing, if you will.

[00:37:09] And so outside of the hospital,

[00:37:11] I had the challenge of trying to sort through the noise

[00:37:15] and create a calm spot

[00:37:17] to actually explain what's actually happening

[00:37:22] from a medical and a scientific perspective.

[00:37:25] So I started these stairwell chronicles

[00:37:28] just to explain and talk to the public.

[00:37:32] I think none of us really knew what to expect from COVID.

[00:37:34] We didn't know there would be multiple variants,

[00:37:36] the alpha and the beta and then the delta

[00:37:38] and the Omicron was just kept going and kept going.

[00:37:40] And so we kept going and kept going.

[00:37:43] Why did you pick the stairwell?

[00:37:45] You know, that is...

[00:37:47] So here's the answer that remember,

[00:37:49] I'm not putting a lot of thought into it.

[00:37:52] I'm not putting any thought at all

[00:37:54] into that this will be a series.

[00:37:56] I was just trying to find someplace

[00:37:58] that could sit down and talk.

[00:37:59] And so originally, I had on my coat,

[00:38:02] it was winter, it was January

[00:38:04] and I really sat outside on my front steps.

[00:38:06] And I said, I'm just gonna sit out here

[00:38:08] on the front steps.

[00:38:09] It's just gonna talk to you like a friend

[00:38:12] and say, hey, here's what's going on with COVID,

[00:38:15] blah, blah, blah.

[00:38:16] But you know, it wasn't gonna do,

[00:38:17] I was just gonna film a few of these, that's it.

[00:38:19] And I got outside and it was overcast

[00:38:23] and I was filming on my iPhone,

[00:38:25] it was hard to see

[00:38:26] and I didn't have that much skill with filming.

[00:38:28] And so eventually I went indoors where I had lights

[00:38:31] and sat on the stairs inside.

[00:38:34] I was just sitting on the steps

[00:38:35] to have a casual conversation.

[00:38:38] And after I started it,

[00:38:40] I named it the stairwell Chronicles.

[00:38:42] Again, it was a temporary name

[00:38:44] and I named it that only because

[00:38:47] I couldn't come up with something catchy.

[00:38:49] So that's how it started by not starting,

[00:38:53] by doing something that you didn't know

[00:38:55] what you were doing,

[00:38:56] that you were starting something right.

[00:38:59] I just wanted to wrap up to ask you two questions.

[00:39:03] First of all, what did I not ask you

[00:39:05] that you thought was important for our audience to know?

[00:39:10] You know, I think it's important

[00:39:12] to know that being a physician is not easy.

[00:39:18] And I think COVID really showed us that it's not easy.

[00:39:22] It doesn't mean that you shouldn't do it.

[00:39:24] And I know I've had so many people

[00:39:26] who want to emulate me,

[00:39:28] but just know that what you see

[00:39:32] doesn't belay what it really takes sometimes

[00:39:38] to really advocate for your patients.

[00:39:41] That requires a lot of energy

[00:39:43] and it requires a lot of effort.

[00:39:46] And you've got to be willing to do that,

[00:39:49] to live up to your, your Hippocratic oath.

[00:39:53] And so I do encourage people to become physicians.

[00:39:56] I encourage minority populations and blacks

[00:39:59] to become physicians.

[00:40:00] I encourage women to be physicians

[00:40:02] because the more and more and more there are of us,

[00:40:05] the less and less and less advocacy

[00:40:08] people like me will have to do.

[00:40:11] If we can normalize just being present

[00:40:15] and being available,

[00:40:16] and it doesn't mean that black people only see black patients

[00:40:19] and Indian people only see Indian patients.

[00:40:22] We all are trained

[00:40:23] and we should all be able to see everyone

[00:40:25] and treat everyone respectfully

[00:40:26] but also understand that different people

[00:40:29] may require different things

[00:40:31] and come from different backgrounds.

[00:40:32] And some people have more advantages

[00:40:34] than other people have had through no fault of their own.

[00:40:38] And here all of humanity lands in your office.

[00:40:44] And I used to think about that when I was in Miami,

[00:40:49] I worked in Miami and there were migrant workers

[00:40:52] that sometimes would come in to the office

[00:40:55] and sometimes I would have executives that would come in

[00:40:57] and their pilots would be waiting for them in the lobby.

[00:41:01] I've got to be able to treat everybody

[00:41:04] to my best ability and make certain

[00:41:07] that the executive whose pilot is waiting for him

[00:41:11] and the migrant worker who's covered in dirt

[00:41:13] from head to toe and is also sick,

[00:41:16] both get my equal attention because they're both humans

[00:41:20] and we've got to remember

[00:41:21] that we're here to serve humanity

[00:41:23] and not make judgment calls on people.

[00:41:27] Well, you answered my second question,

[00:41:28] which is what can we do?

[00:41:29] So Dr. Jane Morgan, thank you so much

[00:41:33] for sharing your experience, your expertise.

[00:41:36] That was a great conversation.

[00:41:38] Loved it.

[00:41:44] As we conclude today's episode,

[00:41:46] I want to thank Dr. Jane Morgan for her profound insights

[00:41:49] and her commitment to inclusivity

[00:41:51] and equity in healthcare.

[00:41:53] Her journey as a black female cardiologist

[00:41:56] is not just inspiring.

[00:41:58] It's also a reminder of the work still needed

[00:42:01] to ensure diversity in all facets

[00:42:03] of medicine and healthcare,

[00:42:04] including research, professional education

[00:42:07] and patient care.

[00:42:09] Let's review some of the highlights of her recommendations

[00:42:12] on how to take charge of your health.

[00:42:14] First, discuss your full medical and family history

[00:42:17] with your healthcare providers,

[00:42:19] including and especially any pregnancy related complications

[00:42:24] even if you're not asked.

[00:42:25] This information is crucial for identifying risk factors

[00:42:29] that can lead to other health conditions.

[00:42:31] And if you're having symptoms of perimenopause

[00:42:34] or even think you are,

[00:42:35] have a conversation with your physician

[00:42:37] about hormones and other treatments.

[00:42:40] Understanding your options

[00:42:41] can significantly impact your long-term health.

[00:42:44] And if you have a chronic condition,

[00:42:47] ask your doctor about available clinical trials.

[00:42:50] Your participation can help ensure

[00:42:52] that medical advancements are effective for everyone.

[00:42:56] By embracing these actions,

[00:42:58] you can improve not only your health

[00:43:00] but also contribute to creating a healthcare environment

[00:43:03] that is equitable and representative of all populations.

[00:43:08] You can follow us for more health news

[00:43:09] and information on our social media

[00:43:11] and sign up for our newsletter

[00:43:13] at beyondthepapergown.com.

[00:43:15] We love to get your comments as well.

[00:43:18] Thanks for joining us and take good care.

[00:43:34] Our episode was produced by Patrick Shambayati and me

[00:43:37] and our associate producer, Iskyle McNoyan.

[00:43:49] If you enjoyed podcasts like this,

[00:43:51] you should check out our other shows

[00:43:53] on HealthPodcast Network.

[00:43:55] For example, Hopeful Hits, hosted by Dr. Tara,

[00:43:58] guides and supports those on the often challenging

[00:44:01] and isolating journey

[00:44:03] of women's health concerns and infertility.

[00:44:05] There's a particularly powerful episode

[00:44:08] that you should check out called

[00:44:10] All Things Endometriosis,

[00:44:12] which dives deep into understanding the condition

[00:44:14] to help the many women who suffer from endometriosis

[00:44:17] and have no idea they have it

[00:44:19] and healthcare providers who are uneducated about it,

[00:44:22] making the diagnosis process so difficult.

[00:44:26] Check out Hopeful Hits on your favorite podcast platform

[00:44:30] or visit healthpodcastnetwork.com.